Background. The need for healthcare in paediatric patients is often due to respiratory diseases, acute diarrhoea and viral fever, which suggests a limited need for the use of antibiotics.Objectives. To identify the determinants of antibiotic prescription in hospitalised paediatric patients in Mozambique.Methods. A cross-sectional study was conducted between January and June 2015. A total of 454 medical prescriptions and clinical records of children aged 0 - 14 years from Hospital Central de Maputo (HCM) and Hospital Geral de Mavalane (HGM) were analysed.Results. Antibiotics were used in 97.6% of the patients, with no significant differences (p>0.05) in the prescription rates of the hospitals. The most commonly used antibiotics were beta-lactams (57.3%), aminoglycosides (28.3%) and co-trimoxazole(9.4%). Antibiotics were prescribed in all cases of bronchopneumonia, fever, sepsis and acute gastroenteritis. For malaria and undefined diagnoses, antibiotics were prescribed 97.8% and 99.3% of cases, respectively. It was clear that most severe clinical conditions (odds ratio (OR) 9.06; 1.13 - 12.14) and age <5 years (OR 5.47;1.54 - 7.60) were treated with antibiotics.Conclusion. The prescription of antibiotics for paediatric patients at both HCM and HGM was largely influenced by patients’ clinical condition and age. It showed that physicians used an empirical approach, in the absence of laboratory tests, often leading to unnecessary antibiotic treatments with negative causative effects. Physicians should be encouraged to use an evidence-based approach for managing the cases correctly.

Background. The need for healthcare in paediatric patients is often due to respiratory diseases, acute diarrhoea and viral fever, which suggests a limited need for the use of antibiotics.Objectives. To identify the determinants of antibiotic prescription in hospitalised paediatric patients in Mozambique.Methods. A cross-sectional study was conducted between January and June 2015. A total of 454 medical prescriptions and clinical records of children aged 0 - 14 years from Hospital Central de Maputo (HCM) and Hospital Geral de Mavalane (HGM) were analysed.Results. Antibiotics were used in 97.6% of the patients, with no significant differences (p>0.05) in the prescription rates of the hospitals. The most commonly used antibiotics were beta-lactams (57.3%), aminoglycosides (28.3%) and co-trimoxazole(9.4%). Antibiotics were prescribed in all cases of bronchopneumonia, fever, sepsis and acute gastroenteritis. For malaria and undefined diagnoses, antibiotics were prescribed 97.8% and 99.3% of cases, respectively. It was clear that most severe clinical conditions (odds ratio (OR) 9.06; 1.13 - 12.14) and age <5 years (OR 5.47;1.54 - 7.60) were treated with antibiotics.Conclusion. The prescription of antibiotics for paediatric patients at both HCM and HGM was largely influenced by patients’ clinical condition and age. It showed that physicians used an empirical approach, in the absence of laboratory tests, often leading to unnecessary antibiotic treatments with negative causative effects. Physicians should be encouraged to use an evidence-based approach for managing the cases correctly.

Background.Knowledge of antibiotic prescribing practice in primary care in South Africa is limited. As 80% of human antibiotic use is in primary care, this knowledge is important in view of the global problem of antibiotic resistance.Objectives. To assess antibiotic prescribing in primary care facilities in the Cape Town Metro District and compare it with current national guidelines, and to assess the reasons why prescriptions were not adherent to guidelines.Methods. A retrospective medical record review was performed in April/May 2016. Records of all patients seen over 2 days in each of eight representative primary care facilities in the Cape Town Metro District were reviewed. The treatment of any patient who raised a new complaint on either of those days was recorded. Prophylactic antibiotic courses, tuberculosis treatment and patients with a non-infection diagnosis were excluded. Treatment was compared with the Standard Treatment Guidelines and Essential Medicines List for South Africa, Primary Healthcare Level, 2014 edition.Results. Of 654 records included, 68.7% indicated that an antibiotic had been prescribed. Overall guideline adherence was 45.1%. Adherence differed significantly between facilities and according to the physiological system being treated, whether the prescription was for an adult or paediatric patient, and the antibiotic prescribed. Healthcare professional type and patient gender had no significant effect on adherence. The main reasons for non-adherence were an undocumented diagnosis (30.5%), antibiotic not required (21.6%), incorrect dose (12.9%), incorrect drug (11.5%), and incorrect duration of therapy (9.5%). Conclusions. This study demonstrates poor adherence to guidelines. Irrational use of antibiotics is associated with increased antibiotic resistance. There is an urgent need to improve antibiotic prescribing practice in primary care in the Cape Town Metro District.

Background.Knowledge of antibiotic prescribing practice in primary care in South Africa is limited. As 80% of human antibiotic use is in primary care, this knowledge is important in view of the global problem of antibiotic resistance.Objectives. To assess antibiotic prescribing in primary care facilities in the Cape Town Metro District and compare it with current national guidelines, and to assess the reasons why prescriptions were not adherent to guidelines.Methods. A retrospective medical record review was performed in April/May 2016. Records of all patients seen over 2 days in each of eight representative primary care facilities in the Cape Town Metro District were reviewed. The treatment of any patient who raised a new complaint on either of those days was recorded. Prophylactic antibiotic courses, tuberculosis treatment and patients with a non-infection diagnosis were excluded. Treatment was compared with the Standard Treatment Guidelines and Essential Medicines List for South Africa, Primary Healthcare Level, 2014 edition.Results. Of 654 records included, 68.7% indicated that an antibiotic had been prescribed. Overall guideline adherence was 45.1%. Adherence differed significantly between facilities and according to the physiological system being treated, whether the prescription was for an adult or paediatric patient, and the antibiotic prescribed. Healthcare professional type and patient gender had no significant effect on adherence. The main reasons for non-adherence were an undocumented diagnosis (30.5%), antibiotic not required (21.6%), incorrect dose (12.9%), incorrect drug (11.5%), and incorrect duration of therapy (9.5%). Conclusions. This study demonstrates poor adherence to guidelines. Irrational use of antibiotics is associated with increased antibiotic resistance. There is an urgent need to improve antibiotic prescribing practice in primary care in the Cape Town Metro District.

The treatment of peptic ulcer disease poses therapeutic challenges to both patients and physicians alike because of the tendency of ulcers to relapse. Drugs used in the treatment of this disease are either costly or are associated with high incidence of adverse effects. Synclisia scabrida is a plant used in ethnomedicine for the treatment of various forms of stomach disorders and menstrual pains. The medicinal properties of the plants are claimed to reside in the roots; stems; and the leaves. Aim : This study; therefore; is to verify this claim and elucidate the probable mechanism of action by using crude stem extracts of this plant on drug- and stress-induced ulcer models in albino mice. Materials and Methods : Crude ethanol and hot water extracts; EE and HWE respectively; of the stem were prepared. These extracts were fractionated and separated by chromatographic methods and the fractions pooled together as fractions (PF-1; PF-2; PF-3 respectively) based on their chromatographic mobility and color reactions. Phytochemical analysis was done on the extracts. Ulcer models were induced in albino mice by means of indomethacin; histamine; and stress after prior cytoprotection with orally administered crude extracts and control (cimetidine). Results : Phytochemical analysis of the crude extracts and their fractions revealed the presence of cardiac glycosides (+++); tannins (+++); saponins (+); flavonoids (++); carbohydrates (++) and alkaloids (+++). Acute toxicity study on the crude extracts and their fractions revealed relative safety at the dose of 5000 mg/kg. The crude extracts (EE and HWE) and their fractions (PF-1; PF-2; PF-3) significantly (P = 0.001) protected against indomethacin-; histamine- and stress-induced ulcers. The decrease in GIT motility produced by these extracts was comparable to that produced by atropine sulfate. Conclusion : The findings suggest that these extracts of Synclisia scabrida possess antiulcer and antispasmodic properties; which justify the claims for its use in the treatment of various forms of stomach disorders.

The treatment of peptic ulcer disease poses therapeutic challenges to both patients and physicians alike because of the tendency of ulcers to relapse. Drugs used in the treatment of this disease are either costly or are associated with high incidence of adverse effects. Synclisia scabrida is a plant used in ethnomedicine for the treatment of various forms of stomach disorders and menstrual pains. The medicinal properties of the plants are claimed to reside in the roots; stems; and the leaves. Aim : This study; therefore; is to verify this claim and elucidate the probable mechanism of action by using crude stem extracts of this plant on drug- and stress-induced ulcer models in albino mice. Materials and Methods : Crude ethanol and hot water extracts; EE and HWE respectively; of the stem were prepared. These extracts were fractionated and separated by chromatographic methods and the fractions pooled together as fractions (PF-1; PF-2; PF-3 respectively) based on their chromatographic mobility and color reactions. Phytochemical analysis was done on the extracts. Ulcer models were induced in albino mice by means of indomethacin; histamine; and stress after prior cytoprotection with orally administered crude extracts and control (cimetidine). Results : Phytochemical analysis of the crude extracts and their fractions revealed the presence of cardiac glycosides (+++); tannins (+++); saponins (+); flavonoids (++); carbohydrates (++) and alkaloids (+++). Acute toxicity study on the crude extracts and their fractions revealed relative safety at the dose of 5000 mg/kg. The crude extracts (EE and HWE) and their fractions (PF-1; PF-2; PF-3) significantly (P = 0.001) protected against indomethacin-; histamine- and stress-induced ulcers. The decrease in GIT motility produced by these extracts was comparable to that produced by atropine sulfate. Conclusion : The findings suggest that these extracts of Synclisia scabrida possess antiulcer and antispasmodic properties; which justify the claims for its use in the treatment of various forms of stomach disorders.